Saline bag under scrutiny in death of little Ruby
AS little Ruby Yan Chen was wheeled out of the Blackwater Hospital she smiled at Dr Marie Carmody-Morris.
"I was happy because I thought she was okay," she told the Coroners Court in Rockhampton yesterday.
"She had improved. Her temperature was down, her heart rate was down ... she looked a much better child."
Forty minutes later the three-year-old went into cardiac arrest aboard a helicopter and at 8.40pm she was sadly pronounced dead at the Rockhampton Hospital.
An autopsy later determined she had died of an air embolism, which occurs when an air bubble enters a vein and blocks it.
Dr Carmody-Morris gave evidence yesterday at the first day of an inquest into Ruby's death.
The court heard Ruby had influenza symptoms when she first arrived at Blackwater Hospital about 11.30am on August 9, 2012.
Dr Carmody-Morris said dehydration was the main concern and Ruby was administered 900ml of saline intravenously.
The court heard Ruby's temperature peaked at 40.2 degrees at 4pm, but had dropped to 38 at 7pm.
Dr Carmody-Morris said she arranged for her to be transferred to Rockhampton for specialised treatment.
She said retrieval paramedic James McManus told her he needed to take the IV lines down as this was "common procedure" for helicopter transfers.
She said she did not discuss the administration of any on-board fluids with him as she thought Ruby had adequate fluid for the short flight.
However, the court heard a further 250ml was administered during the flight.
Neither Dr Carmody-Morris nor enrolled nurse Theresa King, who assisted in Ruby's care that day, could remember seeing a fluid bag with Ruby as she was moved from the hospital to the helicopter.
Both were questioned about the re-use of partial fluid bags. Dr Carmody- Morris said in her 31 years as a qualified doctor she had never re-used a saline bag.
Ms King said she was able to prepare a bag and prime an IV line, but she was not permitted to connect the line to the cannula.
She said she couldn't remember who hooked the lines up to Ruby that day. She agreed that the re-use of a saline bag was dangerous.
"Each time you disconnect it there's a risk of contam
ination or having air enter it," she said. She could not recall Mr McManus requiring to change the mode of IV for the flight.
Mr McManus is expected to give evidence today.